CM: Common Skin Disorders

Question 1

What is the clinical presentation of acne?

Answer 1

non-inflammatory lesions: closed comedones (whiteheads), open comedones (blackheads)
inflammatory lesions: erythematous papules, pustules, nodules or cysts
abscesses and scarring can follow

Question 2

What tests are needed to diagnose acne vulgaris?

Answer 2

none - made by recognizing classic lesions in typical areas

Question 3

What is the clinical presentation of tinea capitis?

Answer 3

scalp ringworm
patchy hair loss w inflammation, scaling, and black dot broken hairs
kerions can look like abscesses

Question 4

What is the clinical presentation of tinea corporis?

Answer 4

trunk or extremity ringworm

erythematous, annular or arciform lesions w well defined scaly or vesicular borders and areas of central clearing

Question 5

What is the clinical presentation of tinea cruris?

Answer 5

jock itch

same appearance as corporis but on groin or buttocks

Question 6

What is the clinical presentation of tinea pedis?

Answer 6

athletes foot

interdigital scaling and maceration

Question 7

What is the clinical presentation of tinea unguium?

Answer 7

inf of nails that can result in discoloration and thickening of nail plate w subungual hyperkeratotic debris

Question 8

What tests are needed to diagnose tinea?

Answer 8

KOH prep of scales
presence of septate branching hyphae = dermatophyte
short hyphae and spores = tinea versicolor
fungal culture of dx in doubt or hair/nail inf
biopsy w special fungal stains

Question 9

What is the clinical presentation of common warts (verruca vulgaris)?

Answer 9

flesh to brown colored hyperkeratotic papules

most frequently hands

Question 10

What is the clinical presentation of filiform warts?

Answer 10

finger-like slender projections that arise on face or neck

usually seen in darker skinned people

Question 11

What is the clinical presentation of flat warts (verruca plana)?

Answer 11

1-3 mm flesh to tan colored papules on face, neck, extensor upper extremities
may be in linear pattern (koebnerization)

Question 12

What is the clinical presentation of condyloma acuminata?

Answer 12

warts growing on moist areas (genital or perianal skin)

most common type of STD

Question 13

What is the clinical presentation of bites from bees, wasps, or yellow jackets?

Answer 13

painful red wheal with central punctum, wheal fades in hrs

rarely life threatening anaphylaxis

Question 14

What is the clinical presentation of fire ant bites?

Answer 14

wheals with TWO hemorrhagic puncta, usually evolve into pustules in hours

Question 15

What is the clinical presentation of a brown recluse spider bite?

Answer 15

skin necrosis, maybe constitutional symptoms (fever, headache, arthralgias, vomiting, maculopapular rash)
“red, white, and blue sign”

Question 16

What is the clinical presentation of seborrheic keratosis?

Answer 16

small flesh, tan or yellow waxy papules that become dark brown or black with greasy surface and well-defined border
have a “stuck on” appearance
larger lesions have white or black dots on surface which are keratin pearls or horn cysts
face, chest and back

Question 17

What is dermatitis papulosa nigra?

Answer 17

form of seborrheic keratosis that manifests as multiple, small, darkly pigmented papules on cheeks and periorbital areas of black, Hispanic and Asian pts (Morgan Freeman)

Question 18

What tests are needed to diagnose seborrheic keratosis?

Answer 18

biopsy if needed to distinguish b/w skin cancer

arising abruptly and in crops = sign of Leser-Trelat - may be cutaneous marker of internal malignancy

Question 19

What is the clinical presentation of irritant contact dermatitis?

Answer 19

erythema and blisters with oozing that later evolve into dry, thickened, fissured pattern
can form following a SINGLE exposure
can result from frequent hand washing

Question 20

What is the clinical presentation of allergic contact dermatitis?

Answer 20

redness, vesiculation with oozing and crusting
more severe rxns produce edematous and vesiculobullous rxns
needs more than 1 exposure for sensitization

Question 21

What tests are needed to diagnose contact dermatitis?

Answer 21

made by presentation

maybe patch testing if allergic and cause unknown

Question 22

What are the basic features of eczema?

Answer 22

red, itchy, edematous skin

Question 23

What are the features of the intrinsic aging process that needs to be distinguished from photo aging?

Answer 23

thinning and loss of elasticity of the skin

Question 24

What is the clinical presentation of photo aging?

Answer 24

texture changes (cutis rhomboidalis of back of neck and sailors, etc), pigmentary changes
thickened, yellow, wrinkled skin
atrophy, vascular changes, telangiectasias, venous lakes
hyperpigmentation: freckles, lentigines (brown macules in elderly, sun-induced)
hypopigmentation: white macules (guttate hypomelanosis)
papular changes
actinic keratoses - pre-malignant lesions, rough sandpaper character
solar elastosis - yellow papules that coalesce into plaque
comedones w cysts around eyes - Favre-Racouchet syndrome = large blackheads admixed w round yellow papules